Chewing tobacco: Not a safe product

Chewing tobacco and other smokeless tobacco products may be perceived as safer than cigarettes or other smoked tobacco products because they aren't linked to lung cancer. And smokeless tobacco products are often promoted as a safer option. These products, however, result in some of the same risks as cigarettes, as well as additional health risks particularly associated with smokeless tobacco products. There are no harmless tobacco products.

Chewing tobacco and other forms of smokeless tobacco

Chewing tobacco is a common type of smokeless tobacco. Smokeless tobacco products consist of tobacco or a tobacco blend that's chewed, sucked on or sniffed, rather than smoked. Nicotine is absorbed through the soft tissues of the mouth and in some cases swallowed.

There are many types of smokeless tobacco products around the world. In the United States, the main types of smokeless tobacco include the following:

Chewing tobacco is packaged either as loose tobacco leaves; leaves compressed into a small, brick-like shape called a plug; or braids of leaves called a twist. A piece of tobacco is placed between the cheek and gum. The saliva that builds up in the mouth is either spit out or swallowed. Chewing tobacco, which may be flavored, is also called chew, spitting tobacco or spit.

Snuff is finely cut or ground tobacco that may be flavored. It's available in dry or moist forms and is packaged in tins or teabag-like pouches. A pinch of snuff is placed along the gumline, either behind the lip or between the gum and cheek. Using snuff is also called dipping. Dry snuff also can be sniffed into the nose.

Snus (pronounced snoos) is a smokeless, spitless, flavored tobacco product that originated in Sweden. It is sold loose or in teabag-like pouches. It's similar to snuff but is pasteurized during the manufacturing process to kill bacteria that can produce cancer-causing chemicals. The snus sold in Sweden is associated with lower risks of cancers linked to chewing tobaccos. However, because snus sold in the United States is not manufactured with the same regulations as the Swedish product, there is insufficient evidence to draw conclusions about U.S. products.

Dissolvable tobacco products are pieces of compressed powdered tobacco that are usually flavored. They dissolve in the mouth, requiring no spitting of tobacco juices. They are sold as orbs or lozenges that resemble hard candy; sticks about the size of a matchstick; or strips that are thin, flat sheets like a dissolvable breath strip. These products are not the same as the nicotine lozenges used to help people quit smoking.

Health risks of smokeless tobacco

All tobacco products contain nicotine, the chemical that makes the products addictive. Also, there are as many as 28 different chemicals, which are either present in tobacco or which form during the production process, that have been identified as cancer-causing agents (carcinogens). These substances in smokeless tobacco products have been linked to well-documented risk of disease.

Health problems related to smokeless tobacco include the following.

Addiction. Because smokeless tobacco contains nicotine, you can become addicted, just as you can with cigarettes. The levels of nicotine circulating in the bloodstream are about the same for people who smoke cigarettes and those who use chewing tobacco. However, unlike smoked tobacco that is used periodically during the day, smokeless tobacco is often used constantly, exposing users to high levels of nicotine throughout the day, resulting in high levels of dependence. Just as with smoking, withdrawal from smokeless tobacco causes symptoms such as intense cravings, increased appetite, irritability and depressed mood.

Cancer. The use of chewing tobacco and other smokeless tobacco products increases the risk of oral cancers — cancer of the mouth, throat, cheek, gums, lips or tongue. There's also an increased risk of cancers of the pancreas and esophagus, the long tube that runs from your throat to your stomach.

Precancerous mouth lesions. Smokeless tobacco increases your risk of developing small white patches called leukoplakia (loo-koh-PLAY-key-uh) inside your mouth. These mouth lesions are precancerous — meaning that the lesions could one day become cancerous.

Pregnancy risk. Studies have shown that the use of smokeless tobacco, including Swedish snus, may increase the risk of stillbirths, low birth weight and heart rate variability in infants.

Poison risk for children. The candy-like appearance or flavors of smokeless tobacco products make them attractive to children. Ingestion of these products can cause nicotine poisoning. Effects of nicotine poisoning in children may include nausea, vomiting, weakness, convulsions, unresponsiveness, impaired breathing and death.

Quitting smokeless tobacco

If you use chewing tobacco or other forms of smokeless tobacco, consider options to help you quit. Because of the health risks of chewing tobacco, smokeless tobacco products are not a good alternative to quit cigarette smoking.

Research about methods to quit smokeless tobacco products is relatively limited, and the effectiveness of strategies for quitting these products is not as well understood as strategies to quit smoking. Nonetheless, guidelines and resources for smoking cessation may be beneficial.

Interventions that have been found most effective in research about quitting chewing tobacco and other smokeless products include the following.

Nicotine replacement therapy with nicotine gum or lozenges, a nicotine replacement that is also absorbed through the lining of the mouth, can help reduce cravings for tobacco products, as can nicotine patch therapy.

Varenicline (Chantix), a non-nicotine prescription medication, can help reduce nicotine withdrawal symptoms by mimicking how nicotine functions in your body.

Behavioral interventions — such as telephone services, self-help materials, counseling or professional advice — can provide you with needed support and help you develop coping skills.

Your doctor can guide you in creating a quit plan and choosing nicotine replacement products or medications to help ensure success. Your doctor also may refer you to local resources or support groups. To reach the National Cancer Institute's telephone quit line, call 877-44U-QUIT (877-448-7848). To find your state's quit line, call 800-QUIT-NOW (800-784-8669).

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